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Management of the Pediatric Pulseless Supracondylar Humeral Fracture: A Systematic Review and Comparison Study of "Watchful Expectancy Strategy" Versus Surgical Exploration of the Brachial Artery.

ΤίτλοςManagement of the Pediatric Pulseless Supracondylar Humeral Fracture: A Systematic Review and Comparison Study of "Watchful Expectancy Strategy" Versus Surgical Exploration of the Brachial Artery.
Publication TypeJournal Article
Year of Publication2019
AuthorsDelniotis, I., Delniotis A., Saloupis P., Gavriilidou A., Galanis N., Kyriakou A., Potoupnis M., Tsiridis E., & Ktenidis K.
JournalAnn Vasc Surg
Volume55
Pagination260-271
Date Published2019 Feb
ISSN1615-5947
Λέξεις κλειδιάAge Factors, Brachial Artery, Closed Fracture Reduction, Humans, Humeral Fractures, Regional Blood Flow, Risk Factors, Treatment Outcome, Vascular Patency, Vascular Surgical Procedures, Vascular System Injuries, Watchful Waiting
Abstract

BACKGROUND: Pulseless hand after a supracondylar humeral fracture (SHF) in children is well known in the bibliography. Although things are clearer in the management of a "pale pulseless hand," controversy still exists about the "pink pulseless hand" (PPH).
METHODS: We reviewed the literature from the electronic database PubMed for studies with main object the vascular injuries after SHF in children and especially the pulseless hand. The primary search terms were "supracondylar humeral fracture" and "vascular injuries". In our final study, 16 articles were gathered and analyzed.
RESULTS: We collected 608 pulseless SHFs, regardless of the vascular status, 203 PPHs, and 109 pale pulseless hands. We compared two different strategy methods when the hand remained pulseless after the reduction and fixation of the fracture: (1) the close observation strategy and (2) the surgical exploration of the artery. The close observation strategy was the treatment of choice in PPH, whereas the surgical exploration of the brachial artery was mostly performed in pale pulseless hands.
CONCLUSIONS: Closed reduction and fixation of the fracture should be the priority in all pulseless SHFs, both pink and pale. In poorly perfused pale hands, after the reduction and fixation of the fracture, there is a chance that radial pulse may return (we found that this chance is approximately 30%). If not, immediate surgical exploration of the artery is strongly indicated. In well-perfused pink hands, the traditional dogma of "watchful waiting" should not be revisited as long as no signs of deterioration of the vascular status appear.
LEVEL OF EVIDENCE: Level I-Systematic review of level I studies.

DOI10.1016/j.avsg.2018.05.045
Alternate JournalAnn Vasc Surg
PubMed ID30081162

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